How leveraging actionable knowledge will strengthen public health efforts.
Mark Dente, M.D.
As the federal government's meaningful-use incentives dismantle the financial obstacles that have long stood in the way of electronic health record (EHR) implementations, individual provider organizations across the country will finally get a chance to realize the clinical and operational benefits associated with the technology. And the industry as a whole will get to put the commonly held “strength in numbers” axiom to the test. As more EHRs materialize, providers can band together to form health information exchanges (HIEs) and leverage the technology to vastly improve public health through the real-time sharing of anonymous HIPAA-compliant data.
The value of having such readily available information has become more apparent in recent years as food-borne illnesses and natural disasters have garnered headline after headline. The sharing of health data certainly could have helped last summer when an Iowa company recalled 380 million eggs after some of its facilities were linked to an outbreak of salmonella.
Health providers could also use real-time shared health data to track into the future the ill effects of disasters. What are the potential health problems resulting from the recent Gulf Coast oil spill? What is the effect on the health of our patients as the oil works through our food chain?
Last summer's flooding on the East Coast is another example. The floods caused many challenges for physicians and hospital staff who did not have immediate access to patient information. Following the floods, Rhode Island's state health director issued a request for information about how the department could harness EHR technology in the future to better deal with the consequences of natural disasters.
To make a real difference in these situations, healthcare organizations will need to leverage EHRs in such a way that goes beyond simply sharing data to actually sharing “actionable knowledge.”
By doing so, providers can use EHRs to support public health efforts by:
• Accessing real-time data to effectively conduct surveillance activities;
• Using automated data to facilitate needs-assessment activities;
• Facilitating the reporting of relevant data to public health agencies;
• Improving communication between healthcare providers and public health agencies;
• Improving implementation and evaluation of public health programs (e.g., immunization, lead poisoning prevention).
To leverage the technology for these public health purposes, though, providers need to agree on what type of clinical data needs to be shared through HIEs. Then, all EHRs need to share uniform data — a huge undertaking in healthcare, where the same condition might be known by a bevy of names, acronyms and abbreviations: a heart attack might be called a myocardial infarction in one system, cardiac arrest in another and an MI in yet another. In addition, the systems need to share relevant information. Sending an overwhelming number of alerts to end-users will lead to “alert fatigue” — and clinicians may simply ignore the warnings totally.
Although the mass adoption of EHRs is still in the offing and the details surrounding the effective development of HIEs are far from standardized, some providers already are leveraging the technology to accrue public health benefits. One organization, for example, works with the Centers for Disease Control and Prevention (CDC) to provide extensive surveillance data for H1N1 and seasonal influenza. Information is gathered as frequently as every 24 hours from a nationwide electronic database consisting of millions of patient records and reported to the CDC to help monitor the spread of the H1N1 virus in near real time. Similar initiatives could add value to the public health efforts at other agencies such as the Food and Drug Administration as well.
Currently, the Alliance of Chicago Community Health Services is piloting an initiative that supports the sharing of anonymous data among providers in the HIE. As a result, if there is an outbreak of salmonella, physicians will receive an alert each time they treat a patient who is at risk for the specific condition. If the patient is not at risk or displaying symptoms, the clinician will not receive the warning. The alliance also provides its member health centers detailed, monthly dashboard reports of performance on national quality measures such as diabetes, coronary artery disease, preventive care and screening and hypertension.
Although these programs are currently the exception, with the full-scale adoption of EHRs emanating from the meaningful-use incentives such efforts eventually will become the norm. The final outcome: EHRs will enable vast improvements in public health efforts..
Mark Dente, M.D., is the chief medical information officer
for GE Healthcare.
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